The decision to operate

On November 26, at 1600 hours, Odim assessed Jesse. At the time, he thought Jesse had a good blood pressure, good pulses and good urine output. While he concurred with Ward's diagnosis, he felt that a one-stage repair would be appropriate. He said he reached this conclusion because he felt that the overall risks in a two-stage repair were greater than the initial risks of a one-stage repair.

With the one stage there is a risk with the procedure, but successful procedure enables one to have the hook-up of the descending aorta with the proximal part using biological tissue that can grow with the child and obviate the necessity for additional procedures at that region. (Evidence, pages 25,816-25,817)

Odim then discussed his intention with Casiro and Ward. Casiro testified that he had reservations about this approach.

Well, I asked him why he was choosing that, and I asked him why wouldn't he go for a staged repair, because the first procedure will be low risk, or lower risk than doing both at the same time, and why wouldn't he wait for the child to grow up, be bigger, before attempting the second procedure? So we had a discussion about that.

But he was very adamant that doing it in two stages would involve two, perhaps three operations, timing and so on and so on, and the combined risk was higher than doing it all at once. And I guess my concern arose from the fact that that wasn't what I was used to with the previous surgeon, in general. (Evidence, pages 37,958-37,959)

According to Casiro, Ward expressed the same concerns that he did. Casiro said that Odim's reasoning seemed valid. Casiro said that while he knew of the slow-down in the PCS program, he assumed that because the program had come back to full speed, whatever problems had existed had been addressed.

Odim then spoke to Swartz, who was the anaesthetist on call, and arranged for the operation to be performed the following day, which was a Sunday.